1. There are many causes of sexual dysfunction in men including mental health disorders
such as depression, anxiety, personality disorders and schizophrenia (Sadock et al., 2017). It
can also be caused by relationship issues, stress, new medications and medical conditions
(Sadock et al., 2017). It important to note that if the sexual dysfunction is caused by a mental
health disorder then only the underlying disorder should be diagnosed (Sadock et al., 2017).
Since there are many different subtypes of sexual dysfunction in order for the nurse
practitioner to diagnose the patient a full psychiatric evaluation would need to be conducted.
To be diagnosed with Male Hypoactive Sexual Desire Disorder the patient would need to
have a decrease in desire for sexual activity and an impact in sexual functioning for a
minimum of 6 months causing significant distress to the client (APA, 2013).
In order to best improve the patient's life a multidisciplinary approach would benefit the
patient which includes a psychologist, psychiatrist, urologist, dietician and physical therapist.
One treatment option that could benefit the patient is psychosexual therapy which would help
the patient not only cope with stress and relationship problems that are secondary to sexual
dysfunction but also help educate the patient on his condition (Diaz et al., 2010).
Psychosexual therapy helps increase communication skills among a couple, reestablish
confidence, decrease performance anxiety, and open discussion between sexual partners
(Diaz et al., 2010). For the nurse practitioner to consider medication the patient would need
labs to evaluate testosterone levels as they can decrease in men with age (Diaz et al., 2010).
Since a decrease in desire and performance issues can be caused by so many things the
provider would need to determine the root cause before medication management. If the
patient were to meet the criteria for depression one medication that could be used is
bupropion which has dopaminergic effects (Sadock et al., 2017). Dopaminergic agents have
been found to increase libido and improve sexual function in some patients (Sadock et al.,
2017).
2. Given that the patient is extremely nervous it is imperative that the provider is able to
establish a therapeutic alliance centered around trust and non-judgment. In order to build a
therapeutic alliance the provider must be sensitive to the topic, have empathy and be able to
listen to the patient. Another important way to address the patient's unique needs is by
implementing solution-focused interviewing. With solution-focusing interviewing the
provider and patient establish goals that helps the patient focus on their particular needs
leading to increase engagement (Cheng, 2007). By establishing goals through solution-
focused interviewing both the patient and provider have a mutual understanding of what the
client needs and values (Cheng, 2007).
3. Up to 25% of men with depression will experience reduce sexual desire and sexual
dysfunction (Rajkumar & Kumaran, 2015). The relationship between sexual dysfunction is bi-
direction: depression can cause a decrease in sexual desire and cause erectile dysfunction, and a
decrease in sexual activity can lead to unsatisfaction and trigger depressive symptoms (Rajkumar
& Kumaran, 2015). Depression can also lower a patient's self-esteem further increasing sexual
dysfunction in a patient's life (Rajkumar & Kumaran, 2015). Studies have shown that men who
have pre-existing anxiety disorders are more likely to experience anxiety related to performance
during sex and an increase in sexual dysfunction (Rajkumar & Kumaran, 2015). One way that a
provider can address these problems is by treating the underlying psychiatric disorder. Since
